Article · 7 min read · Written by Dr. Lisa L. Johnson, M.D.
Fecal incontinence and hemorrhoids: when to seek comprehensive evaluation
Hemorrhoid symptoms and bowel control issues are far more often connected than not. Both deserve evaluation.
A patient came in for hemorrhoid symptoms. Toward the end of the visit, almost as an afterthought, she mentioned that sometimes she has trouble controlling things. Just a little. Probably not worth mentioning.
It was worth mentioning. It usually is.
Why this comes up at a hemorrhoid visit specifically
Hemorrhoids and fecal incontinence sit in the same anatomic neighborhood and share several of the same causes, so it is common for a patient being seen for one to also be quietly living with the other. What is not common is a hemorrhoid-only clinic doing anything with that information. A single-service clinic bands hemorrhoids. It is not staffed or equipped to evaluate bowel control, so when a patient mentions leakage, the typical response is some version of “that’s probably nothing” or a referral to a primary care doctor who was never going to be the right next step either.
That is a missed opening. If you are mentioning it at all, even as an afterthought, it is worth a real look at the same visit.
What we do differently at that same visit
If fecal incontinence comes up while you are here for hemorrhoids, you get an actual workup, not a note to follow up elsewhere:
- A history that asks what kind of leakage, how often, and what you have already changed because of it
- A targeted exam of sphincter tone and pelvic floor coordination
- Anorectal manometry in office when indicated, to measure sphincter strength directly
- Endoanal ultrasound when a prior childbirth injury or anorectal surgery makes sphincter damage a reasonable concern
This happens at the same appointment as the hemorrhoid evaluation. You do not need to come back, and you do not need to bring it up twice.
What to say, and when
If any of the following apply, mention it when you come in for hemorrhoid symptoms, even if it feels like a tangent:
- Any trouble controlling gas or stool, or telling the two apart
- Urgency you cannot always outrun
- Staining or leakage between bowel movements
- Symptoms that started or got worse after childbirth, anorectal surgery, or radiation
Where to go for the full picture
This page exists to catch that moment at the hemorrhoid visit and get you evaluated without delay. For the full explanation of what fecal incontinence is, why it happens, and the complete range of treatment from dietary management through sacral neuromodulation, the fuller article covers that ground in depth. Worth reading either before or after your visit.